PROKSİMAL HUMERUS KIRIKLARINDA TERS OMUZ ARTROPLASTİSİ: INLAY VE ONLAY TASARIM PROTEZLERİN KLİNİK VE RADYOLOJİK SONUÇLARININ KARŞILAŞTIRILMASI

Abstract

Amaç: Proksimal humerus kırıkları (PHK) yaşlı popülasyonda sık görülen ve çok çeşitli tedavi seçenekleri olan kırıklardır. Özellikle kompleks kırıklarda ters omuz artroplastisi (TOA) popüler bir tedavi seçeneği haline gelmiştir. Ancak PHK’daki uygulamalarda farklı TOA tasarımlarının klinik sonuçlara etkisi halen netleştirilememiştir. Bu çalışmada PHK durumunda uygulanan TOA’de inlay (medialize) ve onlay (lateralize) protez tasarımlarının klinik ve radyolojik sonuçlarını karşılaştırmak amaçlanmıştır. Gereç ve Yöntemler: Aralık 2016-Eylül 2023 tarihleri arasında PHK tanısıyla TOA uygulanan hastalar retrospektif olarak incelenmiştir. Grup I (inlay) ve grup II (onlay) olmak üzere kullanılan protezin tasarımına göre iki çalışma grubu oluşturulmuştur. Çalışma grupları, son klinik değerlendirmede elde edilen radyolojik görüntüleme ve klinik sonuçlarına göre karşılaştırılmıştır. Klinik sonuçların değerlendirilmesinde ağrı skoru (görsel ağrı skalası VAS), basit omuz testi (SST) ve subjektif omuz değeri (SSV) kullanılmıştır. Tüberkül iyileşmesinin değerlendirilmesinde ise direkt radyografi görüntülerinden faydalanılmıştır. Bulgular: Çalışmaya 74 hasta dahil edilmiştir. Grup I’de 26, grup II’de ise 48 hasta bulunmaktadır. Hastaların ortalama yaşı 72,4±7,2 yıl ve ortalama takip süresi ise 51,2±25,4 ay olarak bulunmuştur. Tüberkül kaynama oranı grup I’de daha yüksek olmakla birlikte aradaki farkın istatistiksel olarak anlamlı olmadığı görülmüştür (%61,5 vs %54,2, p>0,05). İki çalışma grubu arasında klinik sonuçlar açısından anlamlı fark görülmemiştir (p>0,05). Sonuç: Bu çalışmada hastaların yaklaşık yarısında tüberkül iyileşmesi sağlanamadığı halde klinik sonuçlarda tatmin edici seviyede bir ilerleme elde edildiği görülmüştür. Inlay tasarım protezlerde tüberkül iyileşme oranları daha yüksek olmakla birlikte aradaki farkın anlamlı olmadığı görülmüştür. Bu tasarımın tüberkül iyileşmesi açısından olası üstünlüğünün gösterilmesi için ileri çalışmalara ihtiyaç vardır.

Keywords

• Proksimal humerus kırığı
• ters omuz artroplastisi
• tüberkül iyileşmesi

REVERSE SHOULDER ARTHROPLASTY FOR PROXIMAL HUMERUS FRACTURES: CLINICAL AND RADIOLOGICAL COMPARISON OF INLAY AND ONLAY DESIGN PROSTHESES

Abstract

Objective: Proximal humeral fractures (PHFs) are common among the elderly with numerous treatment options. Especially for comB plex fractures, reverse shoulder arthroplasty (RSA) has become a popular treatment alternative. However, effects of different RSA designs in the setting of PHFs have not been clarified yet. The purpose of this study was to compare the clinical and radiological outcomes of inlay (medialized) and onlay (lateralized) design RSAs performed for PHFs. Material and Methods: A retrospective evaluation was conducted on patients who underwent RSA for PHF between December 2016 and September 2023. The patients were divided into two study groups based on the prosthetic design: Group I (inlay) and Group II (onlay). Clinical and radiological outcome data of the final followB up visits were compared between the study groups. The clinical outcome measures included the pain score (visual analogue scale – VAS), simple shoulder test (SST), and subjective shoulder value (SSV). Tuberosity healing was evaluated using followBup radiographs. Results: A total of 74 patients were included in the study. There were 26 patients in group I and 48 patients in group II. The mean age of the patients was 72.4±7.2 years, and the mean followBup duration was 51.2±25.4 months. The tuberosity healing rate was higher in group I; however, the difference showed no significance (61.5% vs 54.2%, p>0.05). The two study groups were comparable in terms of clinical outcomes (p>0.05). Conclusion: The findings of this study showed that, despite the absence of tuberosity healing in nearly half of the patients, both prosthetic designs resulted in satisfactory clinical outcomes. Although the inlay design group had a higher rate of tuberosity healing, the difference was not statistically significant, and further research is needed to confirm any potential superiority.

Keywords

• Proximal humerus fracture
• reverse shoulder arthroplasty
• tuberosity healing

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